Research indicates that the number of older people is increasing in countries worldwide. However, countries are at different stages of the longevity trend (1). According to International Population Reports, the global population aged 65 years and older already accounts for 8.5% (617 million) of the world’s population and is expected to increase to nearly 17% (1.6 billion) by 2050 (2, 3). China has long entered an aging society, and according to the seventh population census, the proportion of the older population has reached 18.7% as the aging process accelerates (4). As China faces a significant surge in its older population, with an anticipated 400 million people over 65 by 2050 and 150 million people aged 80 and above (5), the demand for gerontological nursing expertise becomes more urgent. To address this challenge, a comprehensive nursing education system is essential to equip students to address the various health needs of the aged population.

Studies have shown that as people age, the physiological functions of older people deteriorate, the likelihood of chronic diseases and accidental injuries escalates, and the prevalence of impairment may persistently rise (6). In China, 74.2% of those aged over 60 have been diagnosed with at least one common chronic illness. The population of older people with disabilities and those who are semi-disabled will continue to rise, accordingly increasing the demand for nursing and life support services (7), as well as for caregivers possessing expertise in gerontology. However, the existing educational and evaluative framework in nursing is inadequate, and the absence of professional training for caregivers hinders their ability to address the complex needs of nursing, which could compromise the well-being of older people.

With advancements in social development, the dimensions of gerontological nursing needs are expanding, becoming increasingly diversified and individualized (8, 9). This places higher demands on the professionalism and overall competence of nursing staff, further highlighting the importance of systematic training and evaluation. It can be said that the tremendous increase in the proportion of older people poses several challenges to gerontological nursing education. Therefore, while society requires an adequate number of nursing staff to deliver care services, it is equally important that these personnel possess comprehensive theoretical knowledge, advanced practical skills, and an excellent level of professionalism. In China, nursing students in higher vocational colleges are the main workforce for gerontological nursing, but there is little research regarding the competency levels of these students.

Clinical competence is defined as the knowledge, skills, attitudes, and abilities to practice safely and effectively without the supervision of others (10), while gerontological nursing competence covers a broad spectrum of nursing practice and includes more than just the skills and knowledge required to provide quality and abundant bedside care. It also focuses on the leadership, need for information, coordination of services and supports, and community engagement needed to improve nursing for the older people across diverse settings (11). Gerontological nursing is defined by the American Nurses Association (ANA) as an evidence-based nursing specialty that focuses on the aging process and the protection and promotion of health and function. The World Health Organization defines gerontological nursing as the provision of nursing care in various care settings for older people as a member of a multidisciplinary health and social care team. It can be concluded that nursing for older people should have sufficient gerontological nursing competence to meet the various requirements. Consequently, to guarantee that nurses exhibit gerontological nursing competence, it is essential to enhance nursing education and the evaluation of such ability (10, 12).

Nursing education in China is categorized as basic nursing education, postgraduate nursing education, and continuing nursing education. Basic nursing education mainly includes secondary nursing education (secondary school) and higher nursing education (including college and undergraduate students), where the curriculum of both secondary technical schools and colleges is a three-year program (13). The purpose of basic nursing education is to prepare students for clinical nursing, community nursing, or follow-up education after graduation (14). Therefore, given the critical role of nurses in gerontological nursing, this study aims to assess the gerontological nursing competence of nursing students in higher vocational institutions and to investigate the factors influencing this competence.

The results of this study show that the total score of gerontological nursing competence of 1777 vocational nursing students is (111.84 ± 23.01), which suggests that the overall gerontological nursing competence of students is at the upper-middle level, which is similar to the conclusion of Tohmola et al. (12). In this study, the dimension of gerontological nursing practice is (30.85 ± 8.45), professional development guidance is (24.60 ± 6.25), communication and cooperation is (27.36 ± 5.80), and legal ethics is (29.02 ± 6.07), which suggests that nursing students are more confident in gerontological nursing practice, communication and cooperation ability, legal and ethical quality, but weaker in professional development guidance ability. The dimension of professional development guidance in this study mainly includes the provision of professional nursing care, health counseling, individual life planning for older people or their families, as well as self-exploration of knowledge related to care, and a focus on nursing development and related topics. Analyzing the results of this study, the low scores in professional development guidance ability may be attributed to nursing students’ completion of gerontological nursing knowledge and assessment, yet their inability to effectively integrate theory and practice due to insufficient practical opportunities. Furthermore, the scores in communication and cooperative skills, as well as legal and ethical standards, are relatively elevated, potentially due to the absence of interactions with real patients and their families throughout class, leading to an optimistic attitude toward communication. A study by Ferretti-Rebustini et al. (15) once pointed out that gerontological nursing competence covers multiple dimensions, but in terms of levels, the most important competence may be practice competence, because the foundation of gerontological nursing depends on clinical competency, which can determine the need for action and follow-up through comprehensive assessment of patients’ problems, while combining clinical judgment and critical thinking to immediately recognize and appropriately manage common conditions in older people. Consequently, in gerontological nursing education, educators and clinical instructors should collaborate on developing strategies for integrating gerontological nursing content, addressing deficiencies in current curricula and practices to enhance nursing students’ competencies. During the instructional process, students may improve their competence in addressing real-world nursing problems through the combination of situational simulation training and case-based teaching, particularly in managing prevalent health issues among older people.

In our study, it was observed that gerontological nursing competence was significantly correlated with years of college and gender (p < 0.01, p = 0.015). It was also observed that second-year nursing students outperformed first-year students (p < 0.01). This is different from the findings of Alqahtani et al., who reported in their study that first-year students had better competence in caring for the older people (16), but similar to the findings of Cheng et al. (17). In the two study institutions, second-year nursing students have completed a specialized gerontological nursing module, which includes nearly 40 h of theoretical instruction and a two-week clinical internship, in contrast to first-year students. This type of curricular variation may contribute to the observation of higher scores among second-year students. The following studies should investigate how the various elements of gerontological nursing curricula influence students’ attitudes and competencies, including course length and clinical practice arrangements.

In addition, male nursing students achieved a higher score (116.24 ± 25.99). It suggests that male nursing students possess a superior self-assessment of gerontological nursing competence, exhibit more favorable attitudes toward the gerontological nursing profession, and may be more likely to pursue gerontological nursing-related employment post-graduation. An integrative review (18) indicated that the different results regarding male and female attitudes toward gerontological nursing across various geographical regions can be attributed to cultural differences and social context, as well as methodological factors such as sample size or bias caused by an inadequate representation of male nurses. In this study, considering that with the increasing social emphasis on gender equality and cognitive development, men are gradually stepping into traditionally female-dominated professions like nursing, male students may receive more attention or support in education, and are often encouraged to show confidence and leadership, which may contribute to their higher self-competence evaluation. Moreover, men are a minority in the nursing profession, and this self-perception may compel them to exert greater effort to demonstrate their expertise and competence in fields traditionally dominated by women. Additionally, it is worth noting that other factors such as career choice motivations and individual personality traits may also influence these gender differences in self-assessed competence. For instance, male nursing students may choose this profession with clearer career advancement goals or stronger personal interest in specialized clinical areas like gerontological care (19), which could enhance their engagement and confidence. According to social role theory, gender stereotypes derive from the discrepant distribution of men and women into social roles both in the home and at work. In the workplace, women have tended to be employed in people-oriented, service occupations rather than things-oriented, competitive occupations, which have traditionally been occupied by men (20). From this, we can infer that personality traits such as higher levels of self-confidence and leadership and assertiveness typically reported among male students could contribute to higher self-evaluation scores.

Our research additionally revealed that prior relationships with grandparents positively influenced gerontological nursing competency, consistent with other findings (21). Approximately 80% of nursing students claimed a better connection with their grandparents, whereas merely 8% reported a deteriorated relationship. From a cultural and social perspective, it is evident that China has historically promoted the concept of filial piety, which has influenced nursing students from a young age, fostering positive attitudes toward older people and resulting in minimal prejudices and stereotypes (14). The difference is that cultural concepts such as long-lived people and those with dementia being “wizards” or “wizards” have been deeply rooted in Ghanaian society for many years. These negative cultural concepts have deeply cultivated wrong notions about aging among nursing students, which may affect their ability to care for the older people (22). Kydd et al. (23) emphasize that the integration of gerontology and cultural competence into the nursing curriculum is essential for the future development of nursing education. Nursing students should be provided with opportunities to reflect on their personal and cultural values. As nursing educators, it is important to facilitate a process through which students critically examine their personal and professional value systems, explore how these values influence their understanding of diverse cultural beliefs, and develop intergenerational interaction and cross-cultural empathy by engaging in multicultural older people care experiences. In the current study, we primarily focused on the Chinese cultural context, particularly the influence of filial piety. The complex role of cultural background in the cultivation of gerontological nursing competence should be further explored in future studies. Evidence from this study suggests that negative experiences in past social relationships with grandparents may be associated with a self-protective mindset among nursing students, which correlates with less positive attitudes toward gerontological nursing and reduced learning initiative. Given these associations, it is advisable for nursing educators to pay attention to students reporting such experiences and consider incorporating targeted educational strategies aimed at fostering empathy and positive perceptions toward older people. Developing individualized gerontological nursing education and training programs might help support these students in forming a more comprehensive and accurate understanding of gerontological nursing (24).

In this study, 42.1% of nursing students reported that they had engaged in gerontological nursing education, and 45.9% of nursing students reported that they had participated in social practice activities related to older people. Statistical analyses indicated that there was a significant difference between this group of students and those who had not participated in this type of study or activity, which is consistent with the results of previous studies (17). A certain amount of gerontological nursing education, experiential learning, and related volunteer experiences would enhance students’ compassion, empathy, and respect for the aged population. As the Knowledge, Beliefs, and Behavior (KAB) (25) model suggests, health knowledge and information are integral to forming positive and accurate beliefs and attitudes and changing health-related behaviors. Beliefs and attitudes are the driving force behind behavior change (26). Consequently, as nursing educators, it is essential to reform teaching methodologies and content tailored to the target audience, enhance the contextualization of the curriculum, and incorporate additional learning experiences regarding older people to improve nursing students’ beliefs and competencies in gerontological nursing.

The findings of this study showed that students with different levels of interest in gerontological nursing had statistically significant differences in their scores on the competency evaluation. The difference is seen in that students exhibiting a greater interest in gerontological nursing attained superior competency evaluation scores. It can also be interpreted that there was a correlation between higher interest and higher willingness to participate. Desire to practice is considered to be an ideological disposition and behavioral motivation to practice, which may influence their actual career choices (27). Therefore, the degree of nursing students’ interest in gerontological nursing will influence their employment orientation post-graduation, making it crucial to enhance this interest through the teaching process (28). Furthermore, it is essential to consider nursing students’ motivation to engage in practice and to offer systematic, standardized, and comprehensive guidance for their career planning, thereby enhancing their employability and professionalism. We believe that engaging with experienced gerontological nursing professionals and establishing early interactions with older people may more effectively foster students’ interest, such as by inviting experts to conduct seminars, career-sharing sessions, and community volunteer initiatives.

This study revealed that most nursing students had moderate to high levels of competency in gerontological nursing, which is crucial for cultivating favorable attitudes about the profession. Statistical analysis revealed that higher ratings of gerontological nursing competence among students correlated with their education in gerontological nursing, participation in gerontological nursing practice, positive social relationships with grandparents, and interest in gerontological nursing. This indicates that achieving a high level of competence in gerontological nursing requires extensive theoretical knowledge in the discipline, advanced understanding of research developments relevant to gerontological nursing, and an appreciation of the culture of aging. It can be concluded that practical teaching in gerontological nursing should be incorporated early in the curriculum of gerontological nursing programs to guarantee that students attain enough clinical competence. Educators must examine the diverse educational backgrounds and life experiences of students, acknowledge their emotional and educational requirements, and facilitate their learning of gerontological nursing in an appropriate way. In addition, longitudinal research will help to understand the dynamic development process of nursing competence, cross-cultural comparative research will expand the applicability of the conclusions, and educational intervention research can promote the progress of global nursing education while verifying different educational strategies. In the future, these studies will help to lay a more solid foundation for cultivating qualified professionals in gerontological nursing.